Wednesday, 10 December 2008

VR (Virtual Reality Therapy)


Here is the accompanying piece [to the above clip] from The New Yorker.

"When it comes to graphics, less is often more. Therapeutic simulations need only be realistic enough to persuade us to play along. The more lifelike a simulation becomes, however, the more we notice its discrepancies with the real thing, says Ari Hollander, who designed the bus-bomb scenario. The goal in therapy is to re-create just enough details so that we engage in the believability, or "presence," of the virtual world, and allow patients to affix their own unique experiences.

The most compelling effects aren't necessarily visual. Researchers found back in the 1990s that very simple elements, such as the noise of a helicopter overhead or the sound of machine-gun fire, were enough to send a veteran several decades back in time. Since then, virtual reality has since been used to treat more benign conditions, such as phobias, or even how to prepare for a job interview. Overcoming a fear of flying is more cost-efficient in the virtual world than on the tarmac."




But before we start getting too carried away with Philip K Dick style "We Can Remember it for you Wholesale" futuristic scenarios, it is worth reading this sobering analysis:


Virtual Reality Exposure Treatment
High Priced Treatment or High Tech Failure?


By Captain Tom Bunn, MSW, CSW, LCSW

For twenty years, as an airline captain and licensed therapist, I have worked successfully with people seeking to overcome fear of flying.

When people ask me about the new Virtual Reality treatment for fear of flying, I am tempted to tell them it is fraudulent, but it is safer to say their claims are just grossly misleading. For example, an article in USA Today on August 18, 2000 states, "A new study has found the computer-based therapy . . . as effective as traditional therapy."

Why is this misleading? Consider what they call traditional therapy. "Those receiving the standard treatment went to an airport, sat on a plane and imagined the flying experience."

This is misleading because the "therapy" Virtual Reality is compared with is neither "traditional therapy" for fear of flying nor adequate treatment for treating fear of flying.

The traditional treatment for fear of flying was developed in the 1970s and made available to fearful fliers by Captain Truman Cummings, Dr. Albert Forgioni, The Fear of Flying Clinic, Carol Stauffer MSW and Captain Frank Petee. It included several hours of lecture on how flying works, how fear arises and how to control it. This was followed by exposure to a parked airliner, and finally an accompanied flight. The effectiveness of these programs in the 1970s far exceeded the results claimed by the new "high tech" treatment in 2000.

Subsequently, SOAR, the program I developed in the 1980s, produced still better results, as shown by research at the University of Tennessee. Further advancements have led to a nearly 100% success rate.

Larry Hodges, Ph.D, cofounder of Virtually Better Inc. states as follows: "Nearly all of the SE and VR patients flew within six months (80% of the VRET group and 90% of the SE group), . . . . " (VRET means Virtual Reality Exposure Therapy and SE means Standard Exposure).

More information and research on VRET:
http://www.apa.org/releases/flyingfear.html

Thus, by his own statistics, even the lame treatment used for comparison had half as many failures as Virtual Reality. When you consider that most people entering treatment can fly but experience great anxiety when doing it, an 80% "success rate" (success meaning how many later fly) may indicate no success at all.

This becomes more obvious in an article in the Psychiatric Times. Michael Kahan, M.D., of Hillside Hospital in Glen Oaks, N.Y. states "The criteria for improvement was simply: did the patients fly?" Forty people entered treatment and thirty-one completed it. Following treatment, only twenty-one (68%) flew.

In an attempt to assess if the treatment had long term effects, only seven responded that they had flown, and some of those reported moderate anxiety.

This info is available at the Psychiatric Times web site at:

http://www.psychiatrictimes.com/p000501b.html

Seven out of 40 people is not, by any stretch of the imagination, a good track record for a $1200.00 treatment.

The problem with the Virtual Reality approach is that people who suffer from fear of flying have such a vivid imagination that they easily create realistic images of impending disaster when flying. These images in their mind's eye are so real that the body reacts to the images as the body does to actual danger. Because the physical reactions that result are the same physical reactions one experiences in actual danger, it can become impossible for the person to separate feelings of danger from actual danger.

In addition, the feelings that result are so intense that the person may have no way to control them. On the ground, when one feels anxious, one naturally seeks to gain control of the situation so as to change it in a way that will alleviate anxiety. If that is not possible, escape is sought. In flight, neither control of the situation nor escape is available leaving the fearful flier no way to control his or her feelings.

The need for control or escape comes from feelings of anxiety. Since neither control nor escape is available, the problem can be addressed only by reducing the anxiety.

Adequate treatment to reduce the anxiety requires neutralization of the images the person already has in the mind. Additional frightening images presented in Virtual Reality Exposure Therapy may only add to the problem. VRET fails because, instead of neutralizing the images the person is already dealing with, it provides even more.

But I make no excuses for the soldier in the following clip. Did he have some inherently sadistic proclivities prior to his tour of duty in Iraq, or was his personality predominantly shaped upon his arrival?:

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